Systemic Anti-Cancer Therapy Regimen Library
BR Adjuvant - AC [DOXOrubicin and CYCLOPHOSPHamide] dose dense followed by PACLItaxel dose dense
Treatment Overview
This regimen consists of two parts: AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense followed by PACLitaxel dose dense.
Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense
Cycle specific Supportive Care Factors:
Emetogenicity: HIGH.
Growth factor support: Recommended for primary prophylaxis.
Cycles 5 to 8 - 14 days - PACLItaxel dose dense
Cycle specific Supportive Care Factors:
Emetogenicity: LOW.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Growth factor support: Recommended for primary prophylaxis.
Cycle details
Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration | 1 to 4 | |
| aprepitant | 125 mg | oral administration | 1 | |
| aprepitant | 80 mg | oral administration | 2, 3 | |
| dexamethasone * | 12 mg | oral administration | 1 | |
| dexamethasone * | 8 mg | oral administration | 2, 3, 4 | |
| ondansetron | 8 mg | oral administration | 1 | |
| DOXOrubicin | 60 mg/m² | intravenous | 1 | 15 minutes |
| CYCLOPHOSPHamide | 600 mg/m² | intravenous | 1 | 60 minutes |
| ondansetron | 8 mg | oral administration | 1 | |
| pegFILGRASTIM | 6 mg | subcutaneous injection | 2 | |
| cyclIZINE | 50 mg Three times daily | oral administration | 1 |
Cycle specific Supportive Care Factors:
Emetogenicity: HIGH.
Growth factor support: Recommended for primary prophylaxis.
Cycles 5 to 8 - 14 days - PACLItaxel dose dense
| Medication | Dose | Route | Days | Max Duration |
|---|---|---|---|---|
| dexamethasone * | 20 mg flat dosing | oral administration | 0, 1 | |
| loratadine * | 10 mg | oral administration | 1 | |
| famotidine * | 20 mg | oral administration | 1 | |
| PACLItaxel * | 175 mg/m² | intravenous | 1 | 3 hours |
| pegFILGRASTIM | 6 mg | subcutaneous injection | 2 | |
| domperidone | 10 mg Three times daily | oral administration | 1 |
Cycle specific Supportive Care Factors:
Emetogenicity: LOW.
Hypersensitivity / Infusion related reaction risk: HIGH - routine premedication recommended.
Growth factor support: Recommended for primary prophylaxis.
Full details
Cycles 1 to 4 - 14 days - AC [DOXOrubicin and and CYCLOPHOSPHamide] dose dense
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. Some centres may choose to omit pre-chemotherapy dose or advise patient to take the night before chemotherapy if patient has to drive to appointment. |
|
| aprepitant | 125 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| dexamethasone * | 12 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy with food. |
|
| ondansetron | 8 mg | oral administration |
Instructions:
ONE hour prior to chemotherapy. |
|
| DOXOrubicin | 60 mg/m² | intravenous | 15 minutes |
Instructions:
Warning vesicant—ensure vein is patent prior to administration, administer vesicant as per institutional policy and monitor for signs of extravasation throughout administration. |
| CYCLOPHOSPHamide | 600 mg/m² | intravenous | 60 minutes | |
| ondansetron | 8 mg | oral administration |
Instructions:
EIGHT hours after chemotherapy OR before bed. |
|
| cyclIZINE | 50 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. Warning: may cause drowsiness. Consider starting dose at 25 mg and increasing as tolerated/required. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. Note that domperidone is not recommended in combination with olanzapine and ondansetron due to potential risk of QT prolongation. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion. |
|
| pegFILGRASTIM | 6 mg | subcutaneous injection |
Day: 3
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| aprepitant | 80 mg | oral administration |
Instructions:
ONCE daily in the morning. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion. |
Day: 4
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| olanzapine * | 5 mg | oral administration |
Instructions:
ONCE daily. This medicine may make you sleepy and make it dangerous to drive or operate machinery. Limit alcohol intake. |
|
| dexamethasone * | 8 mg | oral administration |
Instructions:
ONCE daily in the morning with food. Dose and duration may be individualised at clinician’s discretion. |
Cycles 5 to 8 - 14 days - PACLItaxel dose dense
Day: 0
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 20 mg flat dosing | oral administration |
Instructions:
Take the night prior to PACLItaxel infusion with food. If the initial infusion(s) of PACLItaxel are well tolerated, clinicians may decide at their discretion, to omit this dose. |
Day: 1
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| dexamethasone * | 20 mg flat dosing | oral administration |
Instructions:
ONE hour (or timing as per institutional policy) prior to PACLItaxel infusion with food. |
|
| loratadine * | 10 mg | oral administration |
Instructions:
ONE hour prior to PACLItaxel infusion. |
|
| famotidine * | 20 mg | oral administration |
Instructions:
ONE hour prior to PACLItaxel infusion. Do not take indigestion remedies, iron or calcium preparations within 2 hours of taking this medicine. |
|
| PACLItaxel * | 175 mg/m² | intravenous | 3 hours |
Instructions:
Prepare solution in PVC-free bag and administer via polyethylene lined administration set with an in-line filter of 0.22 microns or less in size. Please carry out graded challenge as per institutional policy. |
| domperidone | 10 mg Three times daily | oral administration |
Instructions:
When required for nausea and/or vomiting. The choice of rescue antiemetic may be substituted to reflect institutional policy or individual patient characteristics. |
Day: 2
| Medication | Dose | Route | Max duration | Details |
|---|---|---|---|---|
| pegFILGRASTIM | 6 mg | subcutaneous injection |
Supportive Care Factors
| Factor | Value |
|---|---|
| Emetogenicity: | Variable |
| Growth factor support: | Recommended for primary prophylaxis |
| Hypersensitivity / Infusion related reaction risk: | Variable |
References
3. Novartis New Zealand Ltd. Paclitaxel Ebewe New Zealand Data Sheet 16 April 2020. https://www.medsafe.govt.nz/profs/Datasheet/p/PaclitaxelEbeweinj.pdf (Accessed 26 November 2020)
* The medicines, doses, combinations, and schedule in this treatment regimen have been carefully reviewed against international best practice guidelines by specialists in medical oncology around New Zealand and this advice has been accepted for publication by Te Aho o Te Kahu (the Cancer Control Agency). Sometimes medicines that are used in routine clinical practice have not been through a formal review process by the NZ Medicines Regulator Medsafe and are therefore considered unapproved or off-label. These medicines are legally able to be prescribed through sections 25 and 29 of the Medicines Act and by obtaining informed consent from patients. All treatment regimens listed on this website have been through robust peer review and are considered an accepted standard of care, whether prescribed through sections 25 or 29 or carrying formal Medsafe Approval.
s29: This symbol indicates that some formulations of the associated medicine are legally only able to be prescribed under section 29 of the Medicines Act. You can see which formulations are section 29 by hovering over the s29 symbol. You can access full medication details from the New Zealand Formulary by clicking on the medication name. Each clinician retains full responsibility for ensuring they have complied with all relevant obligations and requirements of section 29 including obtaining informed patient consent prior to prescribing the applicable medicine.